摘要
目的探讨血清烟曲霉免疫球蛋白G(IgG)抗体联合支气管肺泡灌洗液(BALF)半乳甘露聚糖(GM)检测对肺曲霉菌病的诊断价值。方法选取2016年9月至2018年9月河北燕达医院收治的99例疑似肺曲霉菌感染者为研究对象,根据诊断标准分为对照组(38例)、侵袭组(24例)和慢性组(37例),记录各组研究对象血清烟曲霉IgG抗体和GM抗原诊断结果。结果肺曲霉菌感染者中陈旧性肺结核患者占比最高(26.23%、16/61),其次为慢性阻塞性肺疾病(18.03%、11/61)、肺恶性肿瘤(9.84%、6/61)、支气管哮喘(9.84%、6/61);慢性组患者陈旧性肺结核比例(40.54%、15/37)显著高于侵袭组(4.17%、1/24),差异有统计学意义(χ^2=9.954、P=0.002)。患者临床症状主要是咳嗽、咯痰、呼吸困难、发热和咯血,CT检查主要表现为空洞、曲霉球、多发或弥漫病变等;慢性组患者咳嗽(100.00%、37/37)、咯痰(97.30%、36/37)、咯血(54.05%、20/37)、空洞(83.78%、31/37)及曲霉球(59.46%、22/37)比例均显著高于侵袭组[75.00%(18/24)、75.00%(18/24)、20.83%(5/24)、45.83%(11/24)和16.67%(4/24)],差异均有统计学意义(χ^2=7.634、5.099、6.642、9.776、10.900,P=0.006、0.024、0.010、0.002、0.001)。慢性组患者多发或弥漫病变(13.51%、5/37)、晕轮征患者比例(0.00%、0/37)均显著低于侵袭组[75.00%(18/24)和41.67%(10/24)],差异均有统计学意义(χ^2=23.431、15.525,P均<0.001)。侵袭组和慢性组患者BALF GM抗原[(0.88±0.13、0.98±0.24)kiU/L]、血清烟曲霉IgG抗体水平[(121.96±42.03、153.42±49.67)kAU/L]均显著高于对照组,差异均有统计学意义(t=6.422、9.389、17.395、14.436,P均<0.001)。侵袭组患者血清烟曲霉IgG抗体水平[(121.96±42.03)kAU/L]低于慢性组[(153.42±49.67)kAU/L],差异有统计学意义(t=2.563、P=0.013),但两组BALF GM抗原水平[(0.88±0.13)vs.(0.98±0.24)kiU/L]差异无统计学意义(t=1.868、P=0.067)。血清烟曲霉Ig G抗体以120 kAU/L为临界值时敏感度为62.30%,特异度为81.58%,以140 kAU/L为临界值时敏感度为52.46%,特异度为94.74%,BALF GM抗原以0.5为临界值时敏感度为73.77%,特异度为81.58%,且BALF GM抗原以0.5为临界值时敏感度(73.77%、45/61)显著高于血清烟曲霉Ig G抗体以140 kAU/L为临界值时敏感度(52.46%、32/61),差异有统计学意义(χ^2=5.950,P=0.015)。单独使用BALF GM抗原、血清烟曲霉Ig G抗体诊断曲线下面积分别为0.812和0.771,联合使用时诊断曲线下面积为0.898。结论血清烟曲霉Ig G抗体联合BALF GM检测能够显著提高肺曲霉菌感染者的诊断率。
Objective To investigate the diagnostic value of serum Aspergillus immunoglobulin G(IgG)antibody combined with bronchoalveolar lavage fluid(BALF)galactomannan(GM)detection for pulmonary aspergillosis.Methods From September 2016 to September 2018,a total of 99 patients with suspected pulmonary Aspergillus infection admitted to Yanda Hospital in Hebei Province were selected,and were divided into control group(38 cases),invasion group(24 cases)and chronic group(37 cases)according to the diagnostic criteria.The diagnostic results of serum Aspergillus IgG antibody and GM antigen were recorded,respectively.Results Among the patients with pulmonary aspergillosis,the proportion of old tuberculosis patients was 26.23%(16/61),followed by 18.03%(11/61)of chronic obstructive pulmonary disease,9.84%(6/61)of lung malignant tumors and 9.84%(6/61)of bronchial asthma.The proportion of old tuberculosis in chronic group(40.54%,15/37)was significantly higher than that of invasion group(4.17%,1/24)(χ^2=9.954,P=0.002).The main clinical symptoms of the patients were cough,expectoration,dyspnea,fever and hemoptysis;while the main manifestations of CT were cavity,Aspergillus ball,multiple or diffuse lesions.The proportion of cough(100.00%,37/37),expectoration(97.30%,36/37),hemoptysis(54.05%,20/37),cavity(83.78%,31/37),Aspergillus(59.46%,22/37)in chronic group were significantly higher than that in invasion group[(75.00%,18/24),75.00%(18/24),20.83%(5/24),45.83%(11/24),16.67%(4/24)],with significant differences(χ^2=7.634,5.099,6.642,9.776,10.900;P=0.006,0.024,0.010,0.002,0.001)];while multiple or diffuse lesions(13.51%,5/37)and halo sign(0.00%,0/37)were significantly lower than those of the invasion group[(75.00%,18/24)and 41.67%(10/24)],with significant differences(χ^2=23.431,15.525;all P<0.001).BALF GM antigen[(0.88±0.13,0.98±0.24)kiU/L]and serum Aspergillus fumigatus IgG antibody levels[(121.96±42.03,153.42±49.67)kAU/L]in the invasion and chronic groups were higher than those of the control group,with significant differences(t=6.422,9.389,17.395,14.436;all P<0.001).The serum Aspergillus fumigatus IgG antibody level in the invasion group(121.96±42.03)kAU/L was lower than that in the chronic group[(153.42±49.67)kAU/L],with significant difference(t=2.563,P=0.013),and there was no difference in BALF GM antigen level between the two groups[(0.88±0.13,0.98±0.24)kiU/L],with significant difference(t=1.868,P=0.067).The sensitivity of serum Aspergillus fumigatus IgG antibody with a critical value of 120 kAU/L was 62.30%,the specificity was 81.58%,and sensitivity was determined at a critical value of 140 kAU/L.When the threshold value was 140 kAU/L,the sensitivity was 52.46%,and the specificity was 94.74%.When the BALF GM antigen was 0.5,the sensitivity was 73.77%,and the specificity was 81.58%.The sensitivity[(73.77%,45/61)]of BALF GM antigen at the critical value of 0.5 was significantly higher than that of serum Aspergillus fumigatus IgG antibody at the critical value of 140 kAU/L(52.46%,32/61),with significant difference(χ^2=5.950,P=0.015).The area under the diagnostic curve of BALF GM antigen and serum Aspergillus fumigatus IgG antibody were 0.812 and 0.771,while the area under the diagnostic curve of combined detetion was 0.898.Conclusions The detection of serum Aspergillus fumigatus IgG antibody combined with BALF GM could greatly improve the diagnosis rate of patients with pulmonary aspergillosis.
作者
高立静
安阳
姜敏捷
王君
杨玉龙
刘景娇
王立
Gao Lijing;An Yang;Jiang Minjie;Wang Jun;Yang Yulong;Liu Jingjiao;Wang Li(Department of Respiratory Medicine,Yanda Hospital,Hebei 065201,China)
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2020年第2期104-109,共6页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
基金
河北省卫健委重点科技研究计划(No.20180902)。
关键词
血清烟曲霉免疫球蛋白G抗体
支气管肺泡灌洗液
半乳甘露聚糖
肺曲霉菌
Serum Aspergillus fumigatus immunoglobulin G antibody
Bronchoalveolar lavage fluid
Galactomannan
Pulmonary Aspergillus
